Aortic valve disease is a condition where the valve connecting your heart’s main pumping chamber to your body’s largest artery stops working properly. It either narrows and restricts blood flow, or it fails to close completely and lets blood leak backward. Over 25% of people older than 65 have some degree of degenerative aortic valve disease, and it becomes more common and more severe with age.
How the Aortic Valve Works
Your heart has four valves that keep blood flowing in one direction. The aortic valve sits between the left ventricle (the heart’s strongest pumping chamber) and the aorta, the large artery that carries oxygen-rich blood to the rest of your body. The valve has three crescent-shaped flaps, called leaflets, made of collagen. When the left ventricle contracts, these leaflets open wide to let blood rush into the aorta. When the ventricle relaxes, they snap shut to prevent blood from sliding back in.
This open-and-shut cycle happens with every heartbeat, roughly 100,000 times a day. Over decades, that mechanical stress adds up, which is one reason aortic valve problems are so strongly tied to aging.
The Two Types: Stenosis and Regurgitation
Aortic valve disease takes two forms, and some people develop both at once.
Aortic stenosis happens when the leaflets stiffen and calcify, narrowing the opening the blood must pass through. The left ventricle has to squeeze harder to push blood through the smaller gap. Over time, that extra workload causes the heart muscle to thicken, and eventually the heart can’t keep up. In a healthy valve, the opening measures 3 to 4 square centimeters. Doctors classify stenosis as severe when the opening shrinks below 1 square centimeter or the pressure difference across the valve exceeds 40 mmHg on an ultrasound of the heart. The average stenotic valve loses about 0.1 square centimeters of opening per year, though this varies and tends to be faster in older people and those with heavy calcification.
Aortic regurgitation (also called insufficiency) is the opposite problem. The leaflets don’t close tightly, so blood leaks backward from the aorta into the left ventricle between beats. The ventricle has to handle both its normal fill of blood and the extra blood that leaked back, causing it to stretch and enlarge over time.
What Causes It
The most common cause in developed countries is age-related calcification. Calcium deposits gradually build up on the leaflets, making them stiff and hard to open. This process shares risk factors with heart disease: high blood pressure, high cholesterol, smoking, and diabetes all appear to accelerate it. One in eight people older than 75 has moderate to severe aortic stenosis, and prevalence reaches roughly 10% in those over 80.
The most common congenital cause is a bicuspid aortic valve, where a person is born with two leaflets instead of three. This affects roughly 0.5% to 2% of the population, making it the most common heart defect present at birth. Children with a bicuspid valve and only mild dysfunction rarely see significant progression during childhood. But by adulthood, the abnormal valve wears out faster than a three-leaflet valve, and these individuals face a higher risk of stenosis, regurgitation, aortic aneurysms, and eventual need for valve repair or replacement, often decades earlier than people with age-related disease.
In low- and middle-income countries, rheumatic heart disease remains a major cause. It starts with a strep throat infection that triggers an abnormal immune response. Repeated infections drive chronic inflammation in the valve, leading to scarring, fibrosis, and stiffening of the leaflets. Rheumatic valve disease is the leading cause of cardiovascular death in children and young adults in these regions, particularly among women.
Symptoms and How They Develop
Aortic valve disease is often silent for years. The heart compensates by thickening its walls or enlarging its chambers, so you may feel perfectly fine even as the valve deteriorates. Symptoms typically appear only after the disease reaches a moderate or severe stage, and they tend to show up in a recognizable pattern:
- Shortness of breath, first with exercise, then with less and less activity, and eventually when lying down or sleeping
- Chest pain or tightness, especially during physical effort
- Dizziness or fainting, because the narrowed or leaking valve can’t deliver enough blood to the brain during exertion
- Fatigue that seems out of proportion to your activity level
- Heart palpitations, a feeling of fluttering or pounding in the chest
- Swollen feet and ankles, a sign that the heart is falling behind in its pumping duties
The appearance of symptoms marks a turning point. Once someone with severe aortic stenosis starts experiencing chest pain, fainting, or heart failure symptoms, the condition becomes dangerous if left untreated. Doctors classify this as Stage D, symptomatic severe disease, and it typically prompts serious discussion about valve replacement.
How It’s Diagnosed
A doctor may first suspect aortic valve disease by hearing a heart murmur through a stethoscope. The key diagnostic tool is an echocardiogram, an ultrasound of the heart that shows the valve in motion. It measures how well the leaflets open and close, how fast blood flows through the valve, the pressure difference across the valve, and how the heart muscle is responding.
For aortic stenosis, doctors look at the valve opening area and the pressure gradient to assign a severity grade (mild, moderate, or severe). They also track how the left ventricle is handling the extra workload, checking for thickening, enlargement, or weakening of the heart muscle. These measurements are repeated over time to monitor progression and help decide when intervention is needed.
Treatment Options
No medication can reverse valve calcification or fix a leaky valve. Drug treatment focuses on managing symptoms: reducing fluid buildup, controlling blood pressure, and easing chest pain. For people who are too frail for a procedure, these medications may be the primary option. There has been interest in whether cholesterol-lowering drugs might slow calcification, and some early data suggested a modest effect on the rate of valve narrowing, but this hasn’t been proven in large trials.
The definitive treatment for severe aortic valve disease is replacing the valve. There are two main approaches.
Surgical aortic valve replacement (SAVR) is open-heart surgery where the damaged valve is removed and a new one, either mechanical or made from animal tissue, is sewn in. It has a long track record, proven durability, and lower rates of certain complications like electrical conduction problems in the heart.
Transcatheter aortic valve replacement (TAVR) is a less invasive option. A new valve is threaded through a blood vessel (usually in the leg) and placed inside the old valve without opening the chest. Recovery is faster, and short-term outcomes are comparable to surgery. TAVR is now used across all surgical risk categories, not just for patients considered too high-risk for open surgery.
The choice between the two depends on age, anatomy, and long-term outlook. For younger patients, surgical replacement is often favored as a first procedure because it offers greater durability, lower risk of needing a second procedure down the road, and more flexibility for future interventions. People with a bicuspid valve or unusual anatomy may also be better suited to surgery, since these features can complicate catheter-based approaches. For older patients or those with higher surgical risk, TAVR’s faster recovery and lower upfront stress on the body often tip the balance. These decisions are made by a specialized heart team weighing the tradeoffs for each individual.
Living With Aortic Valve Disease
If you’ve been told you have mild or moderate aortic valve disease without symptoms, the typical path is regular monitoring. That usually means periodic echocardiograms to track whether the valve is getting worse and how your heart is adapting. The interval between checks depends on severity: mild disease might be rechecked every few years, while moderate disease warrants annual imaging.
Managing cardiovascular risk factors matters. Keeping blood pressure, cholesterol, and blood sugar in a healthy range won’t undo valve damage, but it supports overall heart health and may influence how quickly the disease progresses. Staying physically active is generally encouraged for people with mild to moderate disease, though you should know your limits and pay attention to new symptoms like unusual breathlessness or lightheadedness during exercise.
The transition from “watch and wait” to “time for a procedure” hinges on two things: how severe the valve problem has become on imaging, and whether you’re experiencing symptoms. Some people live with mild aortic valve disease for decades without ever needing intervention. Others progress to severe disease within a few years. Knowing what symptoms to watch for, and reporting them early, is the most important thing you can do between checkups.